2 Coast Commercial Credit Credit Application Legal Name of Company Amount Requested Term Requested Use of Proceeds Estimated Funding Date Business Address City State Zip County Equipment Location City State Zip County Contact / Title Phone Number Fax Number Address Federal Tax ID# Years in Business Annual Net Profit Landlord Name & Address Insurance Company Name & Address Type of Business Corp. S-Corp. Partner. Proprietor. L.L.C. Number of Employees Principal Information For All Owners Full Name Home Address City State Zip SSN Date of Birth # of Locations Currently Own % of Ownership Years Experience in Industry Full Name Home Address City State Zip SSN Date of Birth # of Locations Currently Own % of Ownership Years Experience in Industry Full Name Home Address City State Zip SSN Date of Birth # of Locations Currently Own % of Ownership Years Experience in Industry Business Bank References Bank Account Name Account Number Contact Phone Number Balance Business Trade / Loan References Supplier/ Institution Account Name Account Number Contact Phone Number Balance AUTHORIZATION FOR DISCLOSURE OF CREDIT INFORMATION Because I have applied to Coast Commercial Credit, LLC for financing, I hereby authorize you to disclose to Coast Commercial Credit or its assignees the personal and/or business information as may be required concerning the above statements or attached enclosures within the framework of the Fair Credit Reporting Act. I hereby represent to Coast Commercial Credit or its assignees that such information is true, correct and complete. A Photostatted copy of this authorization shall be valid as the original. The applicant agrees that Coast Commercial Credit or its assignees have the right to confirm the accuracy of the above credit information and that Coast Commercial Credit or its assignees have the right to accept or reject this credit application. The applicant understands that Coast Commercial Credit or its assignees are relying on the credit application and financial statements submitted by the applicant in making its decision in whether to approve the credit request. The applicant agrees to inform Coast Commercial Credit or its assignees immediately of any matter that will cause any significant change in the applicant s financial condition. The applicant agrees to irrevocably release Coast Commercial Credit or its assignees from any and all liability associated with this transaction. The applicant irrevocably authorizes Commercial Credit or its assignees to execute and file UCC financing statements and/or execute credit request authorizations in any and all names related to this transaction. SIGNATURE TITLE DATE SIGNATURE TITLE DATE SIGNATURE TITLE DATE SIGNATURE TITLE DATE Coast Commercial Credit, LLC 536 E. Lehigh Drive, Deltona, FL Toll Free Telephone: , Toll Free Facsimile:

3 (PHOTOCOPY FOR EACH APPLICANT) Personal Financial Statement As of, 20 Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan. Name Residence Address City, State, & Zip Code Business Name or Applicant/Borrower Business Phone Residence Phone ASSETS (Omit Cents) LIABILITIES (Omit Cents) Cash on hands & in Banks $ Accounts Payable $ Savings Accounts $ Notes Payable to Banks and Others $ (Describe in Section 2) IRA or Other Retirement Account $ Installment Account (Auto) $ Monthly Payments $ Accounts & Notes Receivable $ Installment Account (Other) $ Monthly Payments $ Life Insurance-Cash Surrender Value $ Loan on Life Insurance $ Only (Complete Section 8) Stocks and Bonds (Describe in Section $ Mortgages on Real Estate (Describe in $ 3) Section 4) Real Estate (Describe in Section 4) $ Unpaid Taxes (Describe in Section 6) $ Automobile-Present Value $ Other Liabilities (Describe in Section 7) $ Other Personal Property $ Total Liabilities $ (Describe in Section 5) Other Assets (Describe in Section 5) $ Net Worth $ Total $ Total $ Section 1. Source of Income Contingent Liabilities Salary $ As Endorser or Co-Maker $ Net Investment Income $ Legal Claims & Judgments $ Real Estate Income $ Provision for Federal Income Tax $ Other Income (Describe below)* $ Other Special Debt $ Description of Other Income in Section 1 *Alimony or child support payments need not be disclosed in Other Income unless it is desired to have such payments counted toward total income. Section 2. Name and Address of Noteholder(s) (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.) Original Current Payment Balance Balance Amount Frequency (monthly, etc.) How Secured or Endorsed Type of Collateral

4 Section 3. Number of Shares Name of Securities (PHOTOCOPY FOR EACH APPLICANT) Cost Market Value Quotation/Exch ange Date of Quotation/Excha nge Total Value Section 4. Type of Property Address Date Purchased Original Cost Present Market Value Name & Address of Mortgage Holder Mortgage Account Number Mortgage Balance Amount of Payment per Month/Year Status of Mortgage Section 5. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.) Property A Property B Property C (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, describe delinquency) Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.) Section 7. Other Liabilities. (Describe in detail). Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies name of insurance company and beneficiaries) I authorize Coast Commercial Credit, LLC, the SBA and or assigns to make inquiries as necessary to verify the accuracy of the statements made to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001). Signature: Date: Social Security Number: Signature: Date: Social Security Number:

7 Affidavit of Ownership / Authority I (Name), as (Position) of (Company Name) located at do hereby certify that the following is a list of shareholders/partners/owners, directors, and officers of the company as of (Date). Shareholders (corporation) Partners (partnership) Owners (proprietorship) Other Directors: Officers: Chairman of the Board President Vice President Secretary Treasurer Other Other Signature _ Date

8 Management Resume (Resume is required for all stockholders, owners, partners, officers, directors, and/or guarantors) Name SS# Date of Birth Place of Birth _ Home Telephone Business Telephone Home Address From To Previous Address From To Spouse s Name SS# Are you employed by the U.S. Government? Yes No If yes, give position Are you a U.S. Citizen? Yes No If No, give Alien Registration Number Have you ever been convicted of any criminal offense other than a misdemeanor involving a motor vehicle violation? Yes No If yes, furnish details in a separate exhibit. Have you ever declared bankruptcy? Yes No If yes, furnish details in a separate exhibit. Do you have any pending lawsuits? Yes No If yes, furnish details in a separate exhibit. Education Name and Location Dates Attended Major Degree or Certificate College: High School: Did you obtain a government student loan for any portion of your education? Yes No Continuing Education Courses: Military Service Branch From To Honorable Discharge? Rank at Discharge Work Experience (list chronologically, beginning with present employment) Company Name/Address From To Title Duties Company Name/Address From To Title Duties Company Name/Address From To Title Duties Professional Associations, Offices Held, etc. Signature _ Date

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